The Process Optimization Process: Design, Model, Execute, Monitor, Optimize

Okay. Back to workflow of workflow. If you look up business process management in Wikipedia, there’s a phrase there which is, “process optimization process,” again, it sounds meta, the process of optimizing a process. It kind of should remind you of that diagram I showed you of the workflow of workflow, the steps between bad workflow to good workflow.

Well, business process management has a life cycle. Here we have design, model, execute, monitor, optimize. It should be similar to what I just described. Design and model, that’s creating the process definition, the process model. Execute it, that’s what the workflow engine or the orchestration engine or the process engine does. Those are approximate synonyms.

Then you’ve got monitoring so while it’s executing, if there’s an exception, if it falls off the happy path, you want a human to intercede and fix the problem. Then optimization, all this data that gets generated can be fed back into reducing cycle time, increasing throughput, decreasing errors, increasing the accuracy with which the goal is achieved and achieving the same amount of work with fewer resources.

If that cycle reminds you of something called PDCA, Plan, Do, Check, Act or Adjust, it should. It’s software-based PDCA. So much of work today in healthcare is being mediated. It is being in … it’s actually in the software and so if you want to improve that work in that workflow, why not use the software to do it?

Global BPM & Health IT Market Size & Growth Rate

This is the last non-healthcare slide. Just to give you a sense of perspective, the global BPM market is about $3 billion and is heading to about $7 billion over the next four years. It’s growing at about 18% a year.

Just to give you a sense of perspective, the health IT market is about a magnitude greater, about eight to 12 or 13 times as big, depending on which year you are looking at in this projection. It’s growing at a rate of about 7%.

Healthcare Needs Business Process Management: 600 Billion Dollars Worth

I strongly believe, and I have been arguing for over a decade, with increasing success, that healthcare needs business process management. Why?

The IOM, Institute of Medicine, estimates that the U.S. wastes more than $765 billion a year, one-third of the total $2.5-plus trillion healthcare economy.

What’s causing this waste? Unnecessary services, medical errors, uncoordinated care, excessive variation, fraud, there’s a great variety here, such a variety. What do all of these have in common? They all have in common, workflow. They are complicated workflows, complicated processes, complicated series of steps consuming resources and achieving goals or maybe in some cases, not achieving goals. If we modeled more of those and we executed those models and we generated the big data necessary to improve those workflows, we could go a long way to reduce the amount of waste in healthcare.

I interviewed the world’s expert on workflow technology. He’s Wil van der Aalst. He’s in the Netherlands. He’s written over 200 papers, chapters, three or four books and about 20 or 30 of his articles are about healthcare. He’s very interested in healthcare and he estimates back-of-the-envelope calculation, mind you, that the U.S. could save as much as $600 billion if we fully adopted process-aware information technology, which is what the academics call, business process management. I think it’s worth reading this quote, “We, the BPM researchers, have a particular interest in healthcare because processes are much more chaotic than in other industries and potential savings are enormous. Healthcare is very challenging, very challenging and therefore there a very interesting application domain.”

EHRs & HIT Efficiency, Effectiveness, User Satisfaction Problems & BPM

All right. Slight change of gear, if you’re in health IT, you know that doctors are complaining about EHR usability. Here are some example headlines: satisfaction is falling. Usability is a bigger issue. We need more user-friendly EHR’s. We’ve got a long way to go and editorials that vendors must solve the usability issues. Guess what?

…These usability issues of EHR is just the tip of the iceberg… Both EHR’s and non-EHR health IT systems have massive problems with effectiveness, efficiency and user satisfaction.

Both EHR’s and non-EHR health IT systems have massive problems with effectiveness, efficiency and user satisfaction. 

What’s so interesting about those three qualities is they are the International Standards Organization’s definition of usability. “Usable products and services are effective, efficient and they make their users, whether they’re someone clicking on a screen or a patient someplace, happy.”

Compare the definition of usability to a definition of business process management. “It is a systematic approach to making an organization’s workflow more effective, more efficient and more capable of adapting to an ever-changing environment.” 

Effectiveness, effective, efficiency, efficient, user satisfaction, I would argue that the single biggest problem with user dissatisfaction with current health IT systems is that they are not capable of adapting and customizing workflow to their local preferences and needs and to do so overtime, to change as the regulatory environment as the business needs change.